Accepting tranfer of patient not qualified to care for...

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    Is there any ethical/legal issues against accepting the transfer of a patient with an issue, being vented for instance, that you aren't experienced with if the hospital provides a support RN 24/7 to manage that aspect of care? In my opinion this shouldn't be an issue, but a lot of people in my class believe this goes against standards of care and so forth. Any thoughts or where I can find doumentation stating why this is acceptable or not would be greatly appreciated. Thanks!!!!!!!
    lindarn likes this.
  2. 16 Comments so far...

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    I don't know if you mean to transfer between different units or from one facility to another. I work in LTC and patients have been sent to us who are not ready to be d/c'd from the hospital. We send them right back to the ER. Most of it is things that the nurse "forgot" to mention in report. I don't know if the hospital doesn't realize that in LTC we have to care for 20+ patients and can't take care of patients who are unstable. I don't know if we accept vents on our unit but we do have some residents with trachs.
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    The legal implications are that once you accept the patient in transfer you are stating that you are accepting responsibility for the patients care and that you are qualified to do so. In the event something happends to the patient in your care you are liable and that you were not qualified to care for the patient will not save you from a lawsuit because you ACCEPTED the assignment. In fact makes you more liable because you should NOT have accepted the patient.

    The support RN ....... is this in the building? and if she is in the building why isn't she caring for the patient. If you weren't qualified to care for the patient you should not have accepted the assignment. Providing a RN for 24/7 "coverage" may or may not be suffucient. If the RN is in the building 24/7 to immediately monitor and evaluate the patient and can take over in the case of an emergency then maybe.

    What type of facility acute care or long term? What are the policies reguarding patients on a vent and who can care for them. Check your state board of nursing and Nurse Practice Act to see what applies to the care of a patient you are not qualified to care for and the right to refuse a patient based upon not being qualifed to care for..........So, essentially your class mates are right......you do have the right and at times the obligation to refuse to accept an assignment in the event you are not qualified to care for them.

    Great question......

    http://www.mbon.org/practice/assignments.pdf




    http://lmgtfy.com/?q=refusing+patient+assignment
    Last edit by Esme12 on May 2, '13
    pinkchris2000, CCL RN, and netglow like this.
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    OP, these are things that should be discussed to great length in school, but, they are not. At least, IMHO not enough to hit home.

    Unlike other jobs, your employer is not as responsible for what you know/don't clinically as some may think. Globally, it is just smarter to think of your job as a nurse as being pretty much on an island (so to speak) for example sake. Imagine yourself on that island when you are at the hospital, imagine nobody there to assist you. If you are confident that you are able to handle "that" kind of patient - alone - then go for it. While you do have the support of your hospital if need be, it's not to the extent most students think it is. In other words, you will never be able to say in court, that you were assigned patients by your employer and that your employer is responsible for knowing your abilities/lack of. That they wouldn't give you a patient assignment if they weren't sure if you could handle it, so it must be OK to take them, is pretty much the farthest from reality. There is no saying, I'm just doing some of it, someone else is supposed to look after the the stuff I am not competent with in this patient. You are somewhat protected when you are on orientation, but when you are off orientation (especially these days) you are your own protector.

    Your license puts you on the hook, and gets them off the hook to an extent.
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    I've received patients that I'm not comfortable with, but luckily I have a lot of resources, so I am willing to step outside of my comfort zone from time to time. If I get any kind of patient on any kind of vent, I call RT and /or ICU and ask them to head over and take a look at things with me. The same goes for chest tubes....even if I think they're alright, I call someone who knows to give me their opinion. I just don't see enough of them to feel competent yet.
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    Here is a scenario:

    Let's say you work in a med surg floor... House supervisor calls you and says we don't have room in our ER, ICU code beds are taken... and well we have a critical patient... your charge nurse informs you of taking this vented multi IV drip unstable ICU patient... mind you you never worked ICU...

    Will you take this and risk this patient coding on you? Remember you are liable... the ink isn't dry on your badge yet, is it worth the risk of thinking you can wing it in caring for this patient or not?

    The unethical aspect of this is you may have a float RN that is in department 24/7 to help u... but that patient's chart and assessment has your name all over it.. so you are 100% liable.. unless of course the FLOAT RN is doing the work assessment her name should be in the chart and they should have ICU patient experience. This is how California law stuff works... I know each state this varies... i know this is off topic, but in the south recovery room ratio is 1 RN to 4-6 patients. in Cali its 1:1 or 1:2:heartbeat
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    You need to have the knowledge skills and experince to care for your pt, if you don't accpet your limiations and the pt comes to harm who you be seen as liable for neglect?
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    You should never take a pt that you are not qualified to care for. I had the experience where it was the weekend, the ER was slammed. The house supervisor calls and wants me to take a pt that was incredibly inappropriate for my floor. I explained to the house sup that I had never cared for a pt with that diagnosis, it was only myself and a new grad on the floor and that the acuity of the pts we already had was very high. He agreed that it would be a bad placement. Later in the day he actually came over and thanked me for standing up for the pt.
    Orange Tree likes this.
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    Got a good one, real world, for you to discuss in class. I work in ICU, and as you can imagine, some days we are full and everyone's called in, and some days I get put on call if we're not full. Let's say I get put on call; our rules are if we get called, we have 1 hour to report to work (we're in a rural area, and some folks have long drives). The charge nurse calls me at midnight, says I need to come in, we're getting slammed. I come in, and my patient is way, way past anything we should handle at our little hospital. Now, what do I do? Refuse the assignment, leaving the pt with either no nurse, or an over worked nurse, or an unqualified nurse? What we did in real world was shift the patients around so that a nurse who'd had an A-line took that pt and I took one of hers (and started learning about A-lines, but they're something where we won't have one for 3 months, then we have 3 at once...). But what would you do if there wasn't someone who'd had an A-line, and this person couldn't be kept in ER, and couldn't be flown out due to weather? And if the charge took the pt from the ER before I got there, is she accepting them for her or for me? And the simple truth is if something went wrong, can you imagine the field day a lawyer would have with that? It wouldn't matter that you were protecting your license if the pt died, you better believe your facility would find a way to throw you under the bus....
    jrwest likes this.
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    Thank you all who have offered the excellent feedback. I have actually seen this situation occur in person. Let's say hypothetically that a pediatric patient was brought back to the PICU post-op placement of a particular device the RN's on the floor aren't trained to handle. Due to regulations restricting the scope of practice of the practitioners in the unit capable of managing the device, the patient could only be admitted to the PICU. An RN from the other unit had to be floated over to support the PICU RN and handle caring for the device.

    Is it reasonable to transfer a patient out of a unit to a unit staffed by RN's not skilled in handling their care so long as an RN is floated over to take care of the patient by themself? I'm thinking location shouldn't really be an issue with simple things like a vent, and if the proper staff is scheduled to care for the patient, this shouldn't be a problem. Thanks again for the input!!!


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